Coagulation Biomarkers in Women with Recurrent Miscarriage and Polycystic Ovarian Syndrome: Systematic Review and Meta-Analysis

Abstract

Introduction Pregnant women with polycystic ovarian syndrome (PCOS) have high risk of pregnancy loss. Pathophysiological mechanisms appear to be associated with obesity, hormonal factors, or blood clotting disorders. Our aim is to perform a systematic review and meta-analysis on the relationship between coagulation disorders and risk of recurrent miscarriage (RM) in patients with PCOS and to identify coagulation biomarkers for this condition.

Material and Methods PubMed and MEDLINE databases were searched for publications in English language. The search terms used included “RM”, “polycystic ovary syndrome”, “coagulation disorders”, and “thrombophilia”. Odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage in different RM groups (with and without PCOS).

Results A total of 575 publications including the search terms were identified. Six studies were included for qualitative analysis, and five were included for quantitative analysis (meta-analysis). We found no association between RM and inherited thrombophilias in patients with PCOS: (1) Factor V Leiden (OR, 0.74; 95% CI, 0.38 – 1.45; p = 0.38); (2) C677T methylenetetrahydrofolate reductase polymorphism (MTHFR) (OR, 1.01; 95% CI, 0.64 – 1.59; p = 0.97); and (3) A1297C MTHFR polymorphism (OR, 1.08; 95% CI, 0.62 – 1.89; p = 0.77). Other potential biomarkers were identified, with emphasis on plasminogen activator inhibitor type 1.

Conclusion Data available in the current literature revealed that there was no association between RM and inherited thrombophilias in patients with PCOS. RM patients with PCOS have a high risk of thromboembolic events.

Zusammenfassung

Einleitung Schwangere Frauen mit polyzystischem Ovarsyndrom (PCOS) haben ein hohes Fehlgeburtsrisiko. Es scheint eine Assoziation zwischen den pathophysiologischen Mechanismen einerseits und Adipositas, hormonellen Faktoren und Koagulationsstörungen andererseits zu geben. Ziel dieser Studie war es, eine systematische Übersicht und eine Metaanalyse über die Beziehungen zwischen Gerinnungsstörungen und dem Risiko wiederholter Fehlgeburten (RM) bei Patientinnen mit PCOS durchzuführen und die Koagulationsbiomarker für diesen Zustand zu identifizieren.

Material und Methode Die Datenbanken von PubMed und MEDLINE wurden nach englischsprachigen Publikationen zu diesem Thema durchsucht. Die hierfür verwendeten Suchbegriffe waren „RM“, „polycystic ovary syndrome“ (polyzystisches Ovarsyndrom), „coagulation disorders“ (Koagulationsstörungen) sowie „thrombophilia“ (Thrombophilie). Die Odds Ratios (ORs) und 95%-Konfidenzintervalle (KIs) für Fehlgeburten wurden für die verschiedenen RM-Gruppen (mit und ohne PCOS) berechnet.

Ergebnisse Insgesamt wurden 575 Artikel mit diesen Suchbegriffen identifiziert. Sechs Studien wurden für die qualitative Analyse und 5 für die quantitative Analyse (Metaanalyse) herangezogen. Wir fanden keine Beziehung zwischen RM und einer vererbten Thrombophilie in Patientinnen mit PCOS: (1) Faktor-V-Leiden (OR, 0,74; 95%-KI, 0,38 – 1,45; p = 0,38); (2) C677T-Methylen-Tetrahydrofolat-Reduktase-Polymorphismus (MTHFR) (OR, 1,01; 95%-KI, 0,64 – 1,59; p = 0,97), und (3) A1297C-MTHFR-Polymorphismus (OR, 1,08; 95%-KI, 0,62 – 1,89; p = 0,77). Es wurden andere potenzielle Biomarker ausgemacht mit einem Schwerpunkt auf den Plasminogen-Aktivator-Hemmer Typ 1.

Schlussfolgerung Die aus der aktuellen Literatur entnommenen Daten zeigten, dass es keine Assoziation zwischen RM und einer vererbten Thrombophilie bei Patientinnen mit PCOS gibt. RM-Patientinnen mit PCOS haben ein höheres Risiko für thromboembolische Ereignisse.

Key words

abortion - biomarker - disturbed ovarian function - polymorphism

Schlüsselwörter

Fehlgeburt - Biomarker - gestörte Ovarfunktion - Polymorphismus

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